A Kidney International commentary discusses the GOAL trial, which tested comprehensive geriatric assessment, delivered as a single outpatient appointment with a geriatrician, for older people living with chronic kidney disease and frailty.
The trial found no improvement in goal attainment. The commentary argues that comprehensive geriatric assessment is established for frailty in general, so the problem is likely the delivery model — a one-off visit without follow-through — rather than the principle.
Frailty is common in advanced CKD and strongly affects decisions about dialysis, conservative care and transplant. A single assessment added to a busy pathway, with no one owning the plan afterwards, may not change what happens to the patient.
The practical lesson for nephrology services is to build person-centred goals into routine care rather than outsourcing them to a single specialist visit.
- Screen older CKD patients for frailty with a simple tool such as the Clinical Frailty Scale
- Ask patients what matters most to them, and record their goals in the kidney care plan
- Make sure someone in the kidney team owns follow-up of any geriatric assessment recommendations
- Revisit goals before decisions about dialysis, conservative care or transplant listing
Why it matters
An intervention that works in general frailty did not work when delivered as a single add-on visit.
Don't overread it
This is a commentary on a negative trial, not evidence that geriatric assessment is unhelpful in CKD.
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